Teeth and drug use

Healthy teeth and gums

Healthy teeth and gums depend on good oral hygiene, a diet low in added sugar, healthy saliva and regular visits to the dentist.

Some drugs can cause tooth damage, so it is important that you tell your dentist about any drugs you are taking. They can tell you if the drug is likely to affect your teeth and what you can do to help prevent dental issues.

Drug use and dry mouth

Some drugs reduce the flow of saliva and cause a condition called dry mouth. Dry mouth significantly increases the risk of tooth decay. Saliva is important because it:

• reduces the population of bacteria in the mouth
• neutralises mouth acids that cause tooth decay
• consistently repairs tooth enamel (the hard surface layer that protects the tooth) that has been damaged by acids in a process known as remineralisation
• has a washing effect that clears food particles away from tooth surfaces.

Talk to your dentist about whether any drugs you are taking could be causing dry mouth.

Drugs can affect teeth and gums

The regular use of drugs can cause significant tooth damage. Some substances may also carry high risk to our oral health, even if we may not consider them drugs:

• Alcohol - regular intake of alcohol can cause a dry mouth and tooth erosion, as most alcohols are acidic. It can also increase your risk of mouth cancer, especially when consumed in combination with smoking.
• Tobacco – smoking is associated with an increased incidence of cancer, gum disease and poor gum healing, including mouth cancer (especially when done in combination with regularly drinking alcohol).
• Cannabis – also called marijuana, pot and weed, can cause dry mouth and can lead to an increased risk of gum problems. Cannabis smoke can increase the risk of mouth cancer.
• Cocaine – also called coke or blow. Users sometimes rub cocaine over their gums, causing ulceration of gums and the underlying bone. When mixed with saliva, cocaine becomes extremely acidic and this erodes tooth enamel and exposes the underlying dentine to decay-causing bacteria. Cocaine and crack cocaine cause dry mouth, which further increases the risk of tooth decay. Cocaine also increases tooth grinding (bruxism) which further wears the teeth.
• Ecstasy (MDMA) – also called the love drug, 'E', 'eckies', 'pingers' or 'caps'. Side effects of ecstasy include tooth grinding, jaw clenching and dry mouth.
• Heroin – also called smack, horse or hammer. People who use heroin tend to crave sweet foods, which can increase the risk of tooth decay if dental hygiene is neglected. Heroin can also cause dry mouth and tooth grinding.
• Methamphetamine – also called ice, crystal meth, glass, shards or puff. This drug causes severe tooth decay in a very short time. The term ‘meth mouth’ is used to describe the extensive damage typically caused by this drug. Methamphetamine contributes to server tooth decay due to dry mouth, high sugar cravings, tooth grinding and poor oral hygenie. Other side effects include facial soreness due to excessive jaw clenching.
• Caffeine is present in many energy drinks and coffee beverages. Most of these are acidic and can cause tooth erosion if consumed often. It is best to limit these drinks and choose water instead to reduce the risk of tooth decay.
• Any drug dependence or drug use that causes a person to neglect their personal hygiene, diet and dental care can significantly increase the risk of dental (and many other) problems.

Myths and misconceptions

A common myth is that tooth damage from drugs happens only because the drug itself is “acidic.” In reality, most harm comes from dry mouth, tooth grinding, poor oral hygiene and frequent intake of sugary or acidic drinks.

Another misconception is that stopping drug use will immediately fix dental problems. While quitting helps prevent further damage, dental treatment is often needed to repair existing issues.

Treating tooth and gum problems

Professional treatment depends on the type of drug and its effects on your teeth and gums. This may include:

• Fluoride strengthens teeth and reduces the risk of decay. The dentist may apply topical fluoride to the surface of your teeth. Fluoride mouthwashes or higher-strength fluoride toothpaste may be recommended for use at home.
• Decayed teeth will need dental fillings or other restorative work such as crowns.
• Badly decayed teeth may need to be removed. Bridges, dental implants or partial or full dentures may be recommended.
• The dentist can recommend various cosmetic treatments (such as veneers) that can improve the look of your mouth and smile if it is important to you.

Preventing tooth and gum problems

Suggestions include:

• If you would like support with addressing a substance use disorder, consider talking to your doctor about support services or entering a drug treatment program.
• Avoid fizzy soft drinks, which are highly acidic and can erode tooth enamel. Drink fluoridated tap water instead.
• Cut back on sweet or sticky foods such as biscuits or lollies.
• Chew sugar-free gum to encourage a steady flow of saliva.
• Pay careful attention to your dental hygiene habits. Brush your teeth thoroughly at least twice a day with standard fluoride toothpaste and floss once a day. Be gentle when cleaning your teeth to avoid damaging the gums.
• Visit your dentist at least once or twice a year where possible.
• Minimise your intake of alcohol.
• Consider quitting smoking.
• Ask your doctor and dentist for further self-care suggestions, and follow them carefully.

Drug use and dental treatment

If you are scheduled for dental treatment, tell your dentist about your alcohol or smoking intake, as well as any drugs you are taking or have recently taken.

Also tell your dentist about any medications you are taking or have recently taken, including prescription, over-the-counter and herbal medications.

Where to get help

• Your dentist
• Your GP (doctor)
• Australian Dental Association – ’Find a dentist’.
• Oral Health Victoria – provides public dental services through the Royal Dental Hospital of Melbourne and community dental clinics, for eligible people.